Letter to Dr. Robert Redfield, Director for the Centers for Disease Control & Prevention - Reed Seeks to Boost Child Immunization Rates

Letter

Dear Dr. Redfield,

We write to express significant concern regarding the recent decline in routine childhood
immunization rates in the United States during the novel coronavirus (COVID-19) pandemic,
and urge you to take immediate action to encourage and support routine pediatric immunizations
through the duration of the COVID-19 pandemic.

According to recent data published by the Centers for Disease Control and Prevention (CDC), a
decline in provider orders for non-influenza childhood vaccines, and measles-containing
vaccines including the measles-mumps-rubella (MMR) vaccine, began one week after President
Trump declared a national emergency on March 13, 2020 due to the COVID-19 pandemic. In
May, the Michigan Care Improvement Registry found a drastic decrease in vaccination rates
among children across nearly every age group. The percentage of children five months and
younger who remain up-to-date on recommended vaccines declined from 67.9 percent in 2019,
to 49.7 percent in May 2020. The New York City health department reported a 63 percent drop
in the number of vaccine doses administered to children between March 23 and May 9, including
a 91 percent drop for children ages 2 and above.

The administration of routine pediatric immunizations remains critical throughout the duration of
this public health emergency. The decline in immunizations is largely attributable to efforts by
families to adhere to social distancing guidelines to reduce both their exposure to, and the spread
of COVID-19. But if this trend of decreased immunization rates among children continues, the
United States could face yet another public health crisis: increased risk of outbreaks of vaccinepreventable diseases. Such outbreaks would put lives at risk, and place additional stress on our health care system and public health infrastructure at a time when these systems are struggling to
respond to the COVID-19 pandemic.

To avoid this potential crisis, we urge the CDC to immediately develop an action plan that
incorporates targeted public outreach and education efforts on addressing vaccine hesitancy and
emphasizing the importance of pediatric immunizations; resources for communities that have
seen reductions in their immunization rates since the start of the COVID-19 pandemic; and
guidance for parents and families on how to safely access pediatric immunizations during the
COVID-19 pandemic, including best practices regarding personal protective equipment (PPE)
use and other precautions to limit the risk of exposure to COVID-19 in health care settings; and
necessary efforts to ensure rapid catch-up for children who are not up to date on critical pediatric
vaccines.

In addition to developing the plans described above, we request that you respond to the following
questions no later than July 1, 2020 to help us better understand how the federal government is
working to address the alarming drop in pediatric immunization rates:

1. What specific steps is CDC taking to reverse the dramatic drop in vaccinations since midMarch?
a. How does CDC plan to capture accurate real-time data on pediatric immunization
rates and identify potential solutions, particularly in vulnerable communities?

2. What outreach and education efforts are underway at CDC to address fears among
parents and families related to bringing children into health care settings during the
COVID-19 crisis?
a. Is CDC planning a public information campaign to address vaccine hesitancy, and
if so, how will CDC ensure that the necessary communication on the importance
of routine immunizations is reaching parents and families?
b. How will CDC ensure that families receive guidance on safe access to care for
children during the COVID-19 pandemic, including the appropriate use of PPE?
c. How will CDC communicate with health care workers, and provide the necessary
tools to inform communities about the importance of receiving pediatric
immunizations during the COVID-19 pandemic?
d. What guidance is CDC providing to pediatricians and other health care workers
on procedures to ensure that they can safely provide and promote routine pediatric
immunizations?
e. Given the significant increase in unemployment due to COVID-19, many families
are finding themselves uninsured. How will CDC raise awareness of the Vaccines
for Children (VFC) program to ensure that families know their children can still
access routine immunizations, and how does CDC plan to support participating
VFC providers as they work to catch up VFC-eligible children on missed
vaccinations, while also preparing for the upcoming flu season?

3. How will CDC monitor the ongoing availability and ordering of pediatric immunizations,
including doses and other essential medical devices, PPE, and other supplies needed to
store, transport and administer vaccines, and what plans are in place to address any
supply chain disruptions?
a. Is CDC taking steps now to ensure that the availability of pediatric
immunizations, and necessary medical devices and supplies, is not impacted when
production and domestic distribution of a COVID-19 vaccine is underway?
4. Has CDC developed or reviewed modeling or projections that predict the potential impact
on future vaccine-preventable outbreaks if the current pediatric immunization rate
continues throughout the duration of the COVID-19 pandemic?
5. Does CDC require additional resources from Congress in order to support efforts to
reverse the decline in pediatric immunizations? If so, what level of funding would be
sufficient?

We appreciate your timely response and look forward to working with you on this critical issue.